Clinician and Staff Perspectives on Implementing Adverse Childhood Experience (ACE) Screening in Los Angeles County Pediatric Clinics

As future healthcare professionals who understand that providing the most effective, patient-centered care possible, we found Alvarado et. al.’s study intriguing. As discussed throughout their article, Adverse Childhood Experience (ACE) screening helps not to only build physician-patient trust, but also aid in eliciting important information. ACEs are extremely stressful events (e.g., abuse, neglect) occurring before the age of 18 years. ACEs result in biological shifts where toxic stress alters hormone levels, immune responses, neural pathways, and/or a decline in mental health. As such, there is great need to routinely screen for ACEs among children seeking routine pediatric care.

Participants (frontline staff, medical clinicians, and psychosocial support staff) noted that lack of adequate time was the main factor contributing to ACE screening not occurring within a primary healthcare setting. The findings highlight the far-reaching consequences of time constraints on not only primary care delivery, but ability to administer ACE screenings as well. Addressing time constraints is vital because ACE screenings could ultimately improve patient outcomes. Given the clear benefits in adopting ACE screenings, what could be done to propel this process of greater uptake in routine primary care pediatric practices?

In addition to time limitations, having access to referral sources was also mentioned as a substantial barrier to ACE screening implementation. Given such paramount influence, why are ACE resources and support services so difficult to obtain and manage? Moreover, what can be done to support primary care offices in providing evidence-based ACE resources to their patients. We are curious to know if primary care practices should all work towards including a social worker as part of their team.